Sakit mata at tadika or taska: how long must my child stay home?

The tadika or taska has sent a message: your child has sakit mata, red and sticky eyes, and cannot come in until it clears. Or the centre has said nothing, and you are wondering whether to send your child at all. Sakit mata is the Malaysian name for contagious conjunctivitis (pink eye), and how long a child must stay home is a question with three different official answers.

This article sets out what the Ministry of Health guideline for taska and prasekolah says, what the NHS, the CDC and the American Academy of Ophthalmology say, and where they disagree. It does not tell you to defy a centre's rule. It explains the rule and the evidence, so you can talk it through with the centre.

How long must my child stay home with sakit mata?

There is no single answer, because the sources differ. The American Academy of Ophthalmology says to stay home until the eyes are no longer red with discharge. The NHS says a child does not need to stay away unless feeling very unwell. The Malaysian guideline says a child suspected of infection is separated and taken for treatment, with a longer exclusion only in some circumstances. Your centre's own policy decides in practice.

So the useful step is to ask the centre for its exclusion policy, and to bring what your child's doctor has said. The rest of this article gives you the background to have that conversation.

What does the Malaysian Ministry of Health guideline say?

The Ministry's guideline for handling children at taska and prasekolah, from July 2007, tells centres to screen children on arrival, and lists "mata merah atau mati bertahi" (red eyes or discharge) among the things to look for. It says centres are advised to have an exclusion policy for any infectious illness, to explain it to parents and hand it out. Sakit mata is on its list of symptoms that carry a risk of infection to other children.

A child suspected of an infectious illness at the centre should be separated in an isolation room, away from other children, while the parents are told at once so the child can see a doctor. Where a doctor confirms an infectious disease, the guideline says the child must not attend until the infectious period is over.

The guideline's disease table gives sakit mata (conjunctivitis) its own row. It describes red, discharging, itchy eyes, spread by fluid from the affected eye, directly or on shared items. It gives the infectious period as as long as there is eye discharge. Prevention is not sharing tissues or handkerchiefs, separating the child, and getting treatment. For exclusion, the table says it is not needed, except when two or more children have symptoms.

So Malaysian guidance points two ways at once. It says to separate a child with red or discharging eyes, and it says routine exclusion is not needed unless there is a cluster. It is also 2007 guidance. The centre's current policy may be stricter or newer, and that policy is what you will be asked to follow.

What do the NHS, the CDC and the American Academy of Ophthalmology say?

They give three different answers, from the most relaxed to the most cautious.

The NHS is the most relaxed. It says you or your child do not need to stay away from work or school unless feeling very unwell. It stresses hygiene instead: wash hands regularly with warm soapy water, do not share towels and pillows, wash pillowcases and face cloths in hot water and detergent, and do not rub the eyes.

The CDC sits in the middle. Its page says that if there is no fever or other symptoms, a child may be allowed to return with the doctor's approval, and that a child should not attend while symptoms remain if the activities involve close contact with others.

The American Academy of Ophthalmology is the most cautious. For bacterial or viral conjunctivitis it says to stay home and avoid contact with other people, and not to return to school until the eyes are no longer red with discharge. It says allergic conjunctivitis is not contagious and those children can stay in school.

Why the difference? The American Academy of Ophthalmology and the CDC describe viral and bacterial pink eye as very contagious, yet their return advice still differs from the NHS. These pages do not settle it. They are policy judgements from different countries, so treat the gap as a real disagreement, not a mistake by any one source.

How long does sakit mata last, and how long is it contagious?

The NHS says conjunctivitis usually gets better in a couple of weeks without treatment, and to seek medical advice if symptoms have not cleared within seven days. The Malaysian guideline treats a child as infectious for as long as there is eye discharge. The American Academy of Ophthalmology uses the same marker: redness with discharge.

None of the sources gives a fixed number of days at home that fits every child, and this article will not make one up. What they agree on is that the discharge and redness are what to watch. By the Malaysian and American Academy of Ophthalmology markers, a child whose eyes are no longer red or discharging is past the stage they set, though the NHS would not have asked for time off at all.

If you are unsure which kind it is, viral, bacterial or allergic, an examination can tell. Our article on pink eye in children explains the types, and our article on allergic eyes in children covers the kind that is not contagious, which the American Academy of Ophthalmology says need not keep a child out.

The centre has a rule and I disagree. What do I do?

Follow the centre's rule and talk to the centre. The Malaysian guideline itself says an operator should have an exclusion policy and share it with parents, so it is fair to ask for it in writing. Ask how the centre decides a child may return, whether it needs a doctor's note, and whether it is following the 2007 guideline or something newer.

Bring your child's doctor into it. A note that names the type of conjunctivitis, and whether the eyes are still discharging, gives the centre something concrete. If the doctor says your child has an allergic cause, that is not contagious, and the American Academy of Ophthalmology says these children can stay in school. Say so, and let the centre decide.

Do not send a child who is unwell. Even the NHS's relaxed advice makes an exception for a child feeling very unwell. Also ask whether the centre is dealing with more than one case, because the Malaysian table names two or more affected children as the point where exclusion becomes worth doing.

How do I stop it spreading at home and at the centre?

Keep towels, pillows, tissues and face cloths separate, and wash hands often. The NHS advises regular handwashing with warm soapy water, not sharing towels and pillows, and washing pillowcases and face cloths in hot water and detergent. The Malaysian guideline says not to share tissues or handkerchiefs contaminated with eye fluid.

The NHS also says not to rub the eyes. Tell the centre, so it can watch for other children. Eyes can also be red for reasons that are not infection at all, such as haze days, swimming or allergy. Our articles on haze days and little red eyes and red eyes after swimming cover those.

When is a red eye not ordinary sakit mata?

When there is pain, sensitivity to light, blurred vision or very red eyes, or when the baby is a newborn. The NHS lists pain, light sensitivity, vision changes and very red eyes as reasons to seek urgent care, and says red, sticky eyes in a baby under 30 days old need an urgent appointment. The CDC says newborns with symptoms of pink eye should be seen by a doctor right away.

These are not things to send a child to the centre with, and not things to manage with a note. See a doctor the same day. If your child is due a check before starting at a tadika, our article on the tadika eye check explains what centres usually ask for.

Common questions

References

1. Kementerian Kesihatan Malaysia · Garis panduan pengendalian kanak-kanak di taska dan prasekolah (Julai 2007) · infosihat.moh.gov.my
2. NHS · Conjunctivitis · www.nhs.uk
3. CDC · About conjunctivitis (pink eye) · www.cdc.gov
4. American Academy of Ophthalmology · Pink eye (conjunctivitis) · www.aao.org

By Dr Chan Li Yen. General information only. It does not replace a consultation. If you are worried about your child's eyes or vision, please see an eye doctor.